Electrocardiographic Left Ventricular Hypertrophy Predicts Cardiovascular Morbidity and Mortality in Hypertensive Patients: The ALLHAT Study

Abstract

<div class="section"> <a class="named-anchor" id="d7571860e228"> <!-- named anchor --> </a> <h5 class="section-title" id="d7571860e229">BACKGROUND</h5> <p id="d7571860e231">Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular (CV) morbidity and mortality. However, the predictive value of ECG LVH in treated hypertensive patients remains unclear. </p> </div><div class="section"> <a class="named-anchor" id="d7571860e233"> <!-- named anchor --> </a> <h5 class="section-title" id="d7571860e234">METHODS</h5> <p id="d7571860e236">A total of 33,357 patients (aged ≥ 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor were randomized to chlorthalidone, amlodipine, or lisinopril. The outcome of the present study was all-cause mortality; and secondary endpoints were CHD, nonfatal myocardial infarction (MI), stroke, angina, heart failure (HF), and peripheral arterial disease. Cornell voltage criteria (S in V ₃ + R in aVL &gt; 28 [men] or &gt;22 mm [women]) defined ECG LVH. </p> </div><div class="section"> <a class="named-anchor" id="d7571860e241"> <!-- named anchor --> </a> <h5 class="section-title" id="d7571860e242">RESULTS</h5> <p id="d7571860e244">ECGs were available at baseline in 26,384 patients. Baseline Cornell voltage LVH was present in 1,741 (7%) patients, who were older (67.4 vs. 66.6 years, <i>P</i> &lt; 0.001), more likely to be female (74 vs. 44%, <i>P</i> &lt; 0001) with a higher systolic blood pressure (151 vs. 146 mm Hg, <i>P</i> &lt; 0.001) than patients without ECG LVH. During 5.0 ± 1.4 years mean follow-up, baseline and in-study ECG LVH was significantly associated with 29 to 98% increased risks of all-cause mortality, MI, CHD, stroke, and HF in multivariable Cox analyses. </p> </div><div class="section"> <a class="named-anchor" id="d7571860e255"> <!-- named anchor --> </a> <h5 class="section-title" id="d7571860e256">CONCLUSIONS</h5> <p id="d7571860e258">Baseline Cornell voltage LVH is associated with increased CV morbidity and all-cause mortality in treated hypertensive patients independent of treatment modality and other CV risk factors. </p> </div><div class="section"> <a class="named-anchor" id="d7571860e260"> <!-- named anchor --> </a> <h5 class="section-title" id="d7571860e261">CLINICAL TRIALS REGISTRATION</h5> <p id="d7571860e263">Trial Number NCT00000542.</p> </div>